Surgical dislocation of the hip: evolving indications - PubMed (original) (raw)

Surgical dislocation of the hip: evolving indications

James R Ross et al. HSS J. 2013 Feb.

Abstract

Background: Femoroacetabular impingement (FAI) is a condition that has become increasingly identified as abnormal, repetitive abutment of the proximal femur and acetabular rim. Safe surgical dislocation of the hip has been popularized as a technique that allows surgeons to not only improve joint preservation procedures but also understand disease patterns more clearly.

Questions/purposes: We describe the technique of surgical dislocation as well as review the indications, results, and complications that are associated with the procedure. We also present various case examples to highlight this technique.

Search strategies: We performed a systematic review of the literature to define the indications, clinical outcomes, and complications associated with surgical dislocation of the hip for the treatment of FAI.

Results: Clinical success rates vary in the literature between 64% and 96% of patients with good results, and conversion to total hip arthroplasty ranging between 0% and 30% in patients who underwent FAI treatment with surgical dislocation. Reported major complication rates have ranged from 3.3% to 6%, most commonly in the form of trochanteric nonunion, neurapraxia, or heterotopic ossification.

Conclusions: FAI deformities encompass a wide spectrum of disease patterns. Surgical dislocation allows full access to the hip in addition to observing its pathomechanics. Strict adherence to proper technique allows the surgeon to minimize complication rates while treating the deformity at hand.

Keywords: FAI; SCFE; femoroacetabular impingement; hip dislocation; perthes.

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Figures

Fig. 1

Fig. 1

Acute on chronic slipped capital femoral epiphysis. a A decreased epiphyseal height and a break in Klein’s line is noted in the right hip on the AP pelvic radiograph. b Frog-leg lateral reveals callus formation at the posterior femoral neck with a severe displacement of the epiphysis (arrow). c Intraoperative image of remodeling of the anterolateral femoral head–neck junction (arrowhead). d Reduction and antegrade fixation of the epiphyseal fragment through the fovea centralis.

Fig. 2

Fig. 2

SCFE treated with Modified Dunn. a Pelvic radiograph shows reconstitution of a more normal femoral head and neck relationship after reduction of the epiphyseal fragment. b Frog-leg lateral also demonstrates improved reduction in addition to an anterior osteochondroplasty. c, d Final radiographs after removal of hardware on the right hip approximately 1 year from her index operation.

Fig. 3

Fig. 3

Acetabular protrusio. a AP pelvic radiograph demonstrates protrusio, elevated lateral center edge angle, negative acetabular inclination, and ossified labrum (arrowhead). b False profile radiograph reveals elevated anterior center edge angle. c, d Dunn view and frog-leg lateral shows circumferential insufficient head–neck offset. e, f Three-dimensional CT scan and an axial slice of a T2-weighted MR arthrogram demonstrates the inadequate arthroscopic femoral osteochondroplasty (arrow) with continued anterolateral prominence (asterisk).

Fig. 4

Fig. 4

Acetabular protrusio. a, b Surgical hip dislocation revealed a circumferentially deep acetabulum, chondromalacia of the superolateral and superior acetabulum (asterisk) and anterior–superior and posterior–superior femoral head, and a 15-mm labral tear, in addition to labral deficiency along the anterior and superolateral rim (arrowhead). c After circumferential osteochondroplasty. d, e Radiographs showing less acetabular coverage and improvement of the head–neck offset. Ant anterior, Post posterior.

Fig. 5

Fig. 5

a, b AP pelvis and false profile radiographs demonstrate coxa magna, coxa breva, coxa vara, and a prominent greater trochanter. c, d Dunn view and frog-leg lateral demonstrate insufficient head–neck offset. Three-dimensional CT (e) also shows this deformity and a T2-weighted MR arthrogram (f) is suggestive of a labral tear (arrow).

Fig. 6

Fig. 6

a, b, c Radiographs demonstrate correction of the head neck offset after osteochondroplasty in addition to an improvement in the trochanteric height. d Aspherical femoral head with an anterolateral prominence, and a full-thickness central defect (arrowhead) of approximately 20 × 15 mm. e Mosaicplasty of the femoral head defect was performed with three donor plugs harvested from anterolateral head that was later resected (f) and recontoured.

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